Madrid, March 8, 2022 - Kidney cancer is one of the 15 most common tumors in Spain, affecting some 8,000 patients a year, mainly men (3 out of 4 patients diagnosed are men)1, with cure rates of up to 80% when diagnosed in time, and it is a tumor where innovation plays a fundamental role in the survival of the patient.
In recent years we have witnessed a great advance in our knowledge of molecular biology, which underlies the development of tumors, and in new drugs for the treatment of patients with metastasis. "Innovation in the world of kidney cancer is continuous," says Dr. Enrique Grande Pulido, head of the Medical Oncology Service at MD Anderson Cancer Center Madrid and head of Clinical Research at MD Anderson Cancer Center Foundation Spain, who points out that over the last 15 years, more than 15 different drugs have been approved to treat the disease when it has already metastasized.
Dr. Grande goes on to say that the drugs that work for metastases now also help prevent the spread of the tumor. “Before, in patients who underwent surgery for a kidney tumor, the kidney or half of it was removed and so they remained disease-free, but there was always the chance that a cell had escaped at some time and was dormant in another organ like the liver, the lungs, the bones or lymph nodes, and that eventually it would reappear”.
"However, with new drugs and rapid access to innovative therapies, we can offer kidney cancer patients who have undergone surgery, treatments to prevent the disease from reappearing, even if it is in another organ".
But this innovation in treatments must go hand in hand with patients having the option of immediate access to the new treatments. It is essential that patients have quick access to available treatments and clinical trials and that they can be operated on with the latest technology, as is the case at MD Anderson Madrid thanks to the center's Clinical Trials Unit and the Da Vinci robot available their operating rooms. This can result in, as Dr. Grande explains, “something as simple as, instead of having to remove the entire kidney, half or three quarters of that kidney being removed while preserving its function. Of course, you can live with a single kidney, but logically if part of the kidney is preserved instead of removing it completely, the contralateral kidney will suffer less to preserve the renal function”.
Advances in treatments in the last 15 years
The treatments available to patients with kidney cancer will depend on the stage of their disease. Surgery is the only therapy that is curative for these patients, but surgery can only be performed when the tumor is localized, or the metastases is very limited. "These are the only patients in whom we can talk about a cure," warns the head of the Medical Oncology Service. Another alternative is radiotherapy, which has a palliative role for people who have metastases in certain places that cannot be controlled with systemic treatments and which, due to the pain they cause, require management.
In the case of patients in whom kidney cancer has spread, there have been great developments in treatment in the last 15 years. Dr. Grande explains that traditionally “these patients were treated with cytokines, interferon or Interleukin-2, very toxic drugs that produced a high percentage of toxic deaths and flu-like symptoms that left patients in bed for several days, and even weeks. Greater knowledge of molecular biology led to the discovery that angiogenesis (the formation of blood vessels) was the most important alteration related to this type of tumor. At present, "we can act pharmacologically to prevent this formation of blood vessels".
These anti-angiogenic drugs can choke the tumor, preventing the blood vessels from providing it with oxygen and nutrients, thus preventing its growth. This knowledge allowed the disease to be controlled for long periods of time, and with fewer adverse effects than those produced by cytokines, Interferon, or Interleukin-2.
Synergies between antiangiogenic drugs and immunotherapy
This pharmacological practice extended over the last decade, but since 4 years ago, immunotherapy drugs have been used. "We have learned that not only does the tumor form blood vessels that help it grow and progress, but it also forms a tumor environment in which infiltration of the immune system is key when tumors develop," says Dr.Grande.
New drugs based on immunotherapy can be used individually or in combination with the antiangiogenic drugs themselves, creating a synergy. This synergy means that the size of the metastasis is reduced, but it also means that the time it takes for the tumor to progress increases and therefore, the survival of patients is extended. “Furthermore, immunotherapy considerably improves the patient's quality of life”.